Active NPI
Charlene Nicole Fisher, DMD
- General Practice Dentistry
- Sanford, FL
National Provider Identifier
1306585344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 26834
- Practice address
- 1601 WP Ball Blvd
Sanford, FL 32771-7208 - Phone
- (407) 547-2230
- NPI assigned
- May 28, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 26834 | FL | Primary |
Addresses
Primary practice location
1601 WP Ball Blvd
Sanford, FL 32771-7208
Mailing address
630 Carvell Dr
Winter Park, FL 32792-2716
Phone (561) 676-7431
Other names 1
- Charlene Nicole Walstrom
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26834 | FL | MD | General Practice Dentistry |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653696000000",
"number": "1306585344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 CARVELL DR",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327922716",
"telephone_number": "561-676-7431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 WP BALL BLVD",
"city": "SANFORD",
"state": "FL",
"postal_code": "327717208",
"telephone_number": "407-547-2230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHER",
"first_name": "CHARLENE",
"middle_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-28",
"last_updated": "2022-05-28",
"certification_date": "2022-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "26834",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "CHARLENE",
"last_name": "WALSTROM",
"middle_name": "NICOLE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Sanford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.